American Journal of Kidney Diseases
Volume 52, Issue 1 , Pages 118-127, July 2008

Accuracy of Patients' Reports of Comorbid Disease and Their Association With Mortality in ESRD

  • Kerri L. Cavanaugh, MD, MHS

      Affiliations

    • Department of Medicine, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, TN
    • Corresponding Author InformationAddress correspondence to Kerri L. Cavanaugh, MD, MHS, Assistant Professor of Medicine, Division of Nephrology, Vanderbilt University Medical Center, 1161 21st Ave S, S3223 MCN, Nashville, TN 37232-2372.
    • ,
  • Sharon Stein Merkin, PhD

      Affiliations

    • Department of Medicine, Division of Geriatrics, Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
    • ,
  • Laura C. Plantinga, ScM

      Affiliations

    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    • Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
    • ,
  • Nancy E. Fink, MPH

      Affiliations

    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    • Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
    • Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • John H. Sadler, MD

      Affiliations

    • Independent Dialysis Foundation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    • ,
  • Neil R. Powe, MD, MPH, MBA

      Affiliations

    • Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    • Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
    • Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
    • Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Received 26 September 2007; accepted 7 February 2008. published online 03 April 2008.

Background

Patient awareness of chronic diseases is low. Unawareness may represent poor understanding of chronic illness and may be associated with poor outcomes in patients with end-stage renal disease (ESRD).

Study Design

Concurrent prospective national cohort study.

Setting & Participants

Incident hemodialysis and peritoneal dialysis patients enrolled in the Choices for Healthy Outcomes in Caring for ESRD Study and followed up until 2004.

Predictor

Inaccurate patient self-report of 8 comorbid diseases compared with the medical record.

Outcomes & Measurements

All-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical measures in the relation of inaccurate self-report to mortality.

Results

In 965 patients, the proportion of inaccurate self-reporters ranged from 3% for diabetes mellitus to 35% for congestive heart failure. Generally, inaccurate self-reporters were older and had more chronic diseases. Greater risk of death was found for inaccurate self-reporters of ischemic heart disease (hazard ratio [HR], 1.34; 95% confidence interval, 1.12 to 1.59; P = 0.001), coronary intervention (HR, 1.46; 95% confidence interval, 1.08 to 1.97; P = 0.01), and chronic obstructive pulmonary disease (HR, 1.40; 95% confidence interval, 1.14 to 1.70; P = 0.001). The greater risk of death remained significant for chronic obstructive pulmonary disease (HR, 1.36; 95% confidence interval, 1.11 to 1.66; P = 0.003) after adjustment for age, sex, and race. In patients receiving peritoneal dialysis, greater risk of death (HR, 2.06; 95% confidence interval, 1.34 to 3.15; P = 0.001) was found for inaccurate self-reporters of ischemic heart disease.

Limitations

Includes potential for residual confounding, medical record error, misclassification of patient accuracy of self-report, and low inaccurate self-report of some chronic diseases, reducing the power to measure associations.

Conclusions

Accuracy of self-report depends on the specific comorbid disease. Patients with ESRD, especially those receiving peritoneal dialysis, who inaccurately report heart disease may be less aware of their chronic comorbid disease and may be at greater risk of mortality compared with those who accurately report their comorbid disease.

Index Words: End-stage renal disease (ESRD), mortality, self-report, awareness, comorbid disease, outcomes

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 Originally published online as doi:10.1053/j.ajkd.2008.02.001 on March 31, 2008.

 Because the Editor-in-Chief recused himself from consideration of this manuscript, the peer-review and decision-making processes were handled entirely by a Co-Editor (Bertrand L. Jaber, MD, MS, Caritas St. Elizabeth's Medical Center) who served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.

PII: S0272-6386(08)00162-5

doi:10.1053/j.ajkd.2008.02.001

American Journal of Kidney Diseases
Volume 52, Issue 1 , Pages 118-127, July 2008

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